Abstract
THE CURRENT policies for cadaver kidney distribution were recently discussed inThe Journal.1Questions about liver allocation are even more important, because there is not the option of artificial organ support.2Two principles of liver deployment have been advocated: efficiency of organ use and urgency of need. THE EFFICIENCY PRINCIPLE Single Disease Studies Primary Biliary Cirrhosis. —Patients with this disease have been stratified retrospectively into low-, medium-, and high-risk categories, and their actual survival after liver transplantation has been compared with the outcome expected without such intervention.3This comparison depended on a Mayo hazard prediction model of the natural history of primary biliary cirrhosis (Table 1).4Before the National Institutes of Health Consensus Development Conference of 1983,5we reserved liver transplantation candidacy for patients with chronic disease whose life expectancy was a few months.6The effect of this restrictive policy could be seen in
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